Demography and community health for healthcare.pdf

Important for your studies

1. Demography &
Community Health
J. A. N. Tharaka
Clinical Instructor
School of Nursing-NawalokaCollege of Professional Studies

2. Learning Objectives
At the end of the session, students will be able to;
Definethetermdemographyandexplainitsrelevancetonursingandcommunity
health.
DescribethepopulationdistributionanddensityofprovincesinSriLankausingrecent
data.
Interpretcensusdatarelatedtomortality,morbidity,andlifeexpectancy.
Explainvitalstatisticsandtheiruseinassessingpublichealthstatus.
AnalysecurrentepidemiologicalpatternsofdiseasesinSriLanka.
Applydemographicknowledgetonursingassessmentandcommunityhealthplanning.
2

3. What is Demography?
Definition
“Demography describes the distribution of disease, death, and other health outcomes
in the population according to person, place, and time, providing a picture of how
populations change and their health needs.“
—Stanhope & Lancaster, Foundations for Population Health in Community/Public Health
Nursing
3

4. Ways Demographic Data Influences Community
Health Nursing
ToAssesstheHealthNeedsofaPopulation
Nursesusedemographicdatatounderstandwhoisatrisk(e.g.,children,theelderly,pregnantwomen).
Ithelpstoidentifythehealthprioritiesofacommunity.
ToPlanandDeliverTargetedHealthPrograms
Knowingthesizeandstructureofapopulationhelpsinplanningmaternalhealthclinics,vaccination
programs,orelderlycareservices.
ToIdentifyHealthTrendsandDiseasePatterns
Demographicstatisticsshowchangesovertime.Nursescandetectrisingtrendslikenon-communicable
diseasesorageingpopulations.
ToReduceHealthDisparities
Demographicdatahelpsnursesrecognizeinequalitiesinhealthcareaccessamongdifferentsocial,
economic,orregionalgroups.
4

5. Ways Demographic Data Influences Community
Health Nursing Cont.
ToSupportEvidence-BasedPublicHealthInterventions
Nursesusedemographicfindingstobackuptheircommunityinterventionsandensuretheymeettheactual
needsofthepopulation.
ToGuideResourceAllocation
Resourceslikemedicines,staff,andequipmentcanbedistributedefficientlybasedonpopulationsizeand
healthstatistics.
ToParticipateinPolicyMaking
Nursescontributetohealthpolicyusingpopulation-baseddata,helpingtoshapenationalhealthstrategies.
5

6. Population Distribution and Density in Sri Lanka
Definition of Population Distribution
“Population distribution describes the way people are spread across a given area and is a key factor in
determining health service delivery and planning in public health.”
—Park, K. (2021). Textbook of Preventive and Social Medicine, 26th ed.
Definition of Population Density ජනඝනත්වය
“Population density is the ratio of people to the physical space they occupy. It helps identify regions
that are over-or under-populated relative to available resources and infrastructure."
—World Health Organization (WHO), 2022
Formula of Arithmetic Density
6

7. Population Distribution and Density in Sri Lanka
Cont.
Types of Distribution Patterns
a.An Even Distribution: Seen in developed countries with planned infrastructure.
b.Clustered Distribution: Populations group around resources (e.g., water bodies, cities).
c.Sparse Distribution: Found in mountainous, forested, or arid regions.
Factors Influencing Population Distribution and Density
Factor Effect on Distribution
Physical Environment Climate, landforms, water availability affect habitability.
Economic Activities Job availability in urban areas attracts more people.
Social Infrastructure Schools, hospitals, transport —more access = more people.
Historical/Political War, resettlement, colonization influence historical population patterns.
Cultural Beliefs Certain ethnic or religious communities cluster together.
7

8. Population Distribution and Density in Sri Lanka
Cont.
Based on the 2024 Census Preliminary Report, Sri Lanka's population shows significant variation in
density across provinces:
Province
Population
(2024)
Density
(persons/km²)
% of National
Population
Western ~6.11million1,578/km² 28.1%
Central 2.71million453/km² –
Southern 2.61million446/km² –
North Western2.58million305/km² –
Eastern 1.78million155/km² –
Uva 1.40million149/km² –
Northern 1.15million119/km² 5.3%
North Central1.41million118/km² –
Sabaragamuwa2.02million393/km² –
Western Province (Colombo,
Gampaha, Kalutara):
The population comprises over
28%of the nation
Density: ~1,578 persons/km²—
highest of all provinces
Northern Province:
Hosts just ~5.3%of the country’s
population
Density: ~119 persons/km²—one of
the lowest provinces
8

9. Urban vs Rural Population Distribution
Definition of Urban Areas
UrbanareasaredefinedasgeographicallydesignatedregionsgovernedbyMunicipalCouncilsorUrban
Councils,characterizedbyhigherpopulationdensity,structuredinfrastructureandgreateraccessto
servicessuchasindustry,trade,healthcare,education,sanitation,andtransportation.
Definition of Rural Areas
Ruralareasaredefinedasallgeographicregionsnotclassifiedasurban,typicallygovernedby
PradeshiyaSabhasinSriLanka.Theseareasarecharacterizedbylowerpopulationdensity,agriculture-
basedeconomies,limitedinfrastructure,andreducedaccesstohealthcare,education,andpublicservices.
Total population: 21.76 million
Urban population: ~3.70 million (≈19.4%)
Rural population: ~15.75 million (≈80.6%)
Urban–RuralRatio
•Forevery1urbanresident,thereareapproximately4rural
residents
•ThisindicatesthatSriLankaremainspredominantlyrural
9

10. Urban vs Rural Population Distribution Cont.
Setting Key Challenges Recommended Health-Care Strategies
Urban(e.g.,
Colombo,
Gampaha)
•Overcrowding increases transmission of infectious
diseases (e.g., dengue, COVID-19).
•Poor waste management and sanitation promote
vector breeding.
•Air and water pollution contribute to respiratory
and cardiovascular illnesses.
•Increased cases of lifestyle-related non-
communicable diseases (NCDs).
•Overloaded health facilities and occasional drug
shortages (especially during economic crises).
•Strengthen urban primary health care with support from local
government and public-private partnerships.
•Improve environmental health: sanitation systems, clean water
supply, solid waste disposal.
•Enhance surveillance systems (e.g., eDCS) and scale up emergency
services (e.g., SuwaSeriya1990).
•Implement robust medical supply chain management for crisis
resilience.
•Promote urban health education campaigns focusing on NCD
prevention and hygiene.
Rural(e.g.,
NCP, Uva)
•Geographical isolation and limited transportation
restrict access to healthcare.
•Shortages of doctors, nurses, essential medications,
and diagnostic tools.
•High incidence of Chronic Kidney Disease of
Unknown Origin (CKD) due to environmental
factors.
•Low health literacy and poverty reduce health-
seeking behaviors.
•Digital divide limits access to telehealth and health
information.
•Deploy mobile clinics and expand telemedicine services to reach
underserved areas.
•Recruit and retain rural health staff through incentives and rural
posting policies.
•Launch targeted community health programs: CKD screening,
water purification, agrochemical education.
•Empower Public Health Midwives (PHMs) and community health
workers for outreach.
•Develop local health education programs in native languages and
culturally appropriate formats.
Urban vs Rural Health System Challenges & Strategies in Sri Lanka
10

11. Census and Vital Statistics
Definition of a Population Census -
සංගණනය“TheCensusofPopulationandHousingisacompleteenumerationofthepopulation,housingunits,andtheir
characteristicsatagivenpointintime,conductedevery10years.”
-DepartmentofCensusandStatistics–SriLanka.(2024).CensusofPopulationandHousing2024–Preliminary
Report.
Sri Lanka Census Overview –2024 Preliminary Findings
Totalpopulation:21,763,170
Populationdensity:~337persons/km²
Mid-yeargrowthtrend(2018–2023):Declininggrowth(from+1.05%to–0.65%)withcurrentnegativerate(–0.65%)
Themid-yeargrowthtrendreferstotheannualpopulationgrowthrateestimatedbetweenmid-years(typicallyJuly1stofeach
year),basedonbirths,deaths,andmigration
Agepyramidshift:Increasingmedianage(from21.4yearsin1981to~31yearsin2012),indicatingpopulationageing
Medianageistheageatwhichhalfthepopulationisyoungerandhalfisolder
11

12. Census and Vital Statistics Cont.
Vital Statistics
Crude Birth Rate (CBR)
CrudeBirthRateisthenumberoflivebirthsper1,000peopleinagivenpopulationoverayear.
Itiscalled“crude”becauseitdoesnottakeintoaccounttheageorsexstructureofthepopulation.
CBR = (Number of Live Births / Mid-Year Population) * 1,000
•According to the 2024 Preliminary Census Report, Sri Lanka’s CBR is 10.1 births per 1,000 population.
•The rate has been declining due to increased literacy, family planning access, and urbanization.
CrudeDeathRate(CDR)
CrudeDeathRateisthenumberofdeathsoccurringduringaspecificyearper1,000mid-yearpopulation.
Thisrateprovidesasnapshotofoverallmortalityinapopulation,thoughitdoesnotdifferentiatebyageorcause.
CDR=(Totalnumberofdeathsinayear/Totalmid-yearpopulation)*1000
•ForSriLankain2024,theCDRisapproximately7.8per1,000,aslightdeclinefrom8.2in2023.
•CrudeDeathRatetrendsinSriLankahavedecreasedfromaround8.1in2022to7.8in2024.
12

13. Census and Vital Statistics Cont.
Key Vital Indicators
Natural Increase
Natural increase refers to the net change in population size due to births and deaths only ignoring migration.
This indicates whether the population is growing or shrinking based purely on natural factors.
It is calculated as:
NaturalIncreaseRate(per1,000)=CrudeBirthRate−CrudeDeathRate
•Natural Increase = 10.1 –7.8 = 2.3 per 1,000 (≈0.23% annual growth)
•A positive natural increase means births exceed deaths, contributing to population growth.
•Sri Lanka’s moderate rate (~2.3‰)reflects:
Declining fertility (due to improved family planning and women's education)
Relatively low mortality (thanks to good healthcare and public health interventions)
13

14. Census and Vital Statistics Cont.
IndicatorDefinition
Latest Sri
Lanka Data
Community Health
Implications
Nursing & Community Strategies
Infant
Mortality
Rate (IMR)
Deaths of
infants (<1
year) per
1,000 live
births
5.3 per 1,000
(2023); slight
decline from 5.5
(2022)
Indicates
neonatal/infant health
and effectiveness of
birth & postnatal care,
immunization,
nutrition, hygiene.
•Ensureinstitutionaldeliverieswithskilledbirthattendants.
•Conductearlypostnatalfollow-ups(within24–48hoursand
7days).
•Promoteexclusivebreastfeeding(initiatewithin1hour;
continuefor6months).
•ImplementPHM-ledhomevisitsforinfantweightchecks,
immunization,andparentalguidance.
•Usedigitalhealthtools(mobilealerts,tele-nursing)totrack
immunizationandpostnatalcare.
•Educatecaregiversondangersigns:fever,poorfeeding,
difficultybreathing.
14

15. Census and Vital Statistics Cont.
IndicatorDefinition
Latest Sri
Lanka Data
Community Health
Implications
Nursing & Community Strategies
Under-Five
Mortality
Rate
(U5MR)
Deaths of
children (<5
years) per
1,000 live
births
6.0 per 1,000
(2023)
Reflects broader child
health—including
diarrhea, pneumonia,
nutrition, and care-
seeking.
•Strengthen Integrated Management of Childhood Illnesses (IMCI),
especially for diarrheaand pneumonia.
•Ensure full immunization coverage (e.g., DTP3, MMR, Pentavalent).
•Provide growth monitoring and nutrition support through well-baby
clinics.
•Conduct health education sessions on hygiene, safe drinking water,
and sanitation.
•Promote Vitamin A supplementation and deworming in high-risk
areas.
•Empower PHMs to focus on malnourished and developmentally
delayed children in estate and rural sectors.
Maternal
Mortality
Ratio
(MMR)
Maternal
deaths per
100,000 live
births due to
pregnancy/c
hildbirth
complication
s
~30 per
100,000
(latest
WHO/World
Bank
estimates)
Low rate reflects strong
maternal care systems,
but continued vigilance
needed—especially in
rural/remote areas.
•• Ensure minimum four quality ANC visits, including early
registration and screenings (BP, blood group, anemia, GDM).
•Guarantee 100% skilled birth attendance and timely referral in high-
risk pregnancies.
•Provide Magnesium Sulfate (MgSO₄) for eclampsia and oxytocin for
postpartum hemorrhage.
•Offer postnatal care within 24 hours, 3 days, 7 days, and 6 weeks
post-delivery.
•Train PHMs and CHNs in risk identification, emergency signs, and
maternal verbal autopsy.
15

16. Census and Vital Statistics Cont.
Life Expectancy at Birth -ආයුඅපේක්ෂාව
Defined as the average number of years a newborn is expected to live under current mortality conditions.
Latest Data (2024):
•Overall Life Expectancy: 77.73 years (up from 77.48 in 2023)
•Male: ~74.25 years
•Female: ~80.90 years
Healthy Life Expectancy (HALE)
The average number of years a person is expected to live in good health, without significant illness or disability.
HALE in 2021: 66.7 years (up from 65.0 in 2012)
Morbidity Rate -පරෝගාතුරවීම
Morbidity refers to the presence of disease, illness, injury, or disability within an individual or population. It is
measured by incidence (new cases) and prevalence (total cases) of specific conditions
16
Total Fertility Rate
The average number of children born to a woman over her reproductive life.
TFR 2023: Approximately 1.974 births per woman, below the replacement level of 2.1
Downward Trend: From 2.007 in 2020 to 1.995 in 2021, and 1.984 in 2022, consistent with delayed
childbearing and smaller family norms.

17. Age Structure
•0–14 years: ~22% (~5.13 million children)
•15–64 years: ~66% (~13.6 million working-age)
•65+ years: ~12% (~1.6 million elderly)
This distribution reflects a maturing population, with a shifting focus toward elderly care.
Age structure is a demographic indicator that reflects the proportion of the population in different
age groups, which influences public policy, health planning, and economic development."
—Department of Census and Statistics, Sri Lanka (2024)
Census and Vital Statistics Cont.
“The dependency ratio is the average number of economically dependent individuals (under 15 or over 64 years)
per 100 working-age individuals (15-64 years).”
—Department of Census and Statistics, Sri Lanka (2024)
Total Dependency: ~53.7 dependents per 100 working-age individuals
Youth Dependency: ~35.4
Elderly Dependency: ~17.8 (up from ~17.3 in 2022)
Dependency Ratios
17

18. Census and Vital Statistics Cont.
Importance of Vital Statistics in Public Health Planning
Disease Surveillance & Public Health Response
•Death certificateswith cause-of-death data enable tracking of disease patterns, outbreak detection, and resource
allocation .
Health Service Planning & Policy Making
•Birth and death ratesguide planning in maternal-child health, vaccination programs, chronic disease clinics, and
emergency response services
Measuring Health System Performance
•Indicators derived from vital events (infant mortality, maternal mortality, life expectancy) are essential to assess
progress toward national and global goals (e.g., SDGs, UHC)
Identifying Vulnerable Populations
•Disaggregated vital stats spotlight high-risk groups (e.g., regions with high maternal/infant mortality, elder deaths, or
CKDuprevalence), facilitating targeted interventions
Legal, Social & Economic Protection
•Birth/death records grant individuals legal identity—for education, health access, citizenship—and support efficient
social protection mechanisms
18

19. Epidemiological Patterns of Disease
What is Epidemiology?
වසංගතපේදය“The study of the distribution and determinants of health-related states or events in specified populations,
and the application of this study to the control of health problems.”
—World Health Organization (WHO, 2024)
Goals of Epidemiology
Identify the causes of diseases and health conditions –Discover risk factors and modes of transmission
Measure the frequency and burden of diseases –Use incidence, prevalence, and mortality rates to assess population health
Study the natural history and progression of diseases –Understand how diseases develop, spread, and resolve over time
Evaluate the effectiveness of health interventions –Assess real-world impact of vaccines, screenings, and treatment programs
Support public health planning and policy-making –Provide evidence to guide healthcare resource allocation and priorities
Prevent and control disease in populations –Design programs to reduce risk, promote health, and control outbreaks
Identify groups at highest risk–Detect vulnerable populations needing targeted interventions
19

20. Epidemiological Patterns of Disease Cont.
Key Epidemiological Terms
Incidence-සිදුවීම
Incidenceis the number of new cases of a disease occurring in a specified population during a defined time period.
Prevalence -පැතිරීම
Prevalence is the total number of cases(both new and existing) of a disease in a population at a given point or over a period
of time.
Endemic-ආපේණික
Endemicrefers to the constant presence or usual prevalence of a disease within a geographic area or population group.
Epidemic -වසංගතය
An epidemicis the occurrence in a community or region of cases of an illness in excess of normal expectancy.
Pandemic -ේයාේතවසංගතය
A pandemicis an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually
affecting a large number of people.
Notifiable Disease
A disease that, by legal requirement, must be reported to public health authorities when diagnosed by healthcare professionals,
to allow for monitoring, control, and prevention of outbreaks. 20

21. Epidemiological Patterns of Disease Cont.
Epidemiological patternsrefer to how diseases occur, spread, and persist in a specific population over time. In
Sri Lanka, these patterns reflect a dual burdenof both communicable and non-communicable diseases, along
with growing environmental and demographic influences.
Epidemiological Transition in Sri Lanka
Sri Lanka is experiencing a third-stage epidemiological transition, characterized by:
Declining infectious disease mortality due to improved primary health care.
Rising non-communicable diseases (NCDs) and aging-related morbidities.
Persistence of infectious disease pockets in rural and underserved regions.
Emerging environmental and lifestyle-related diseases, e.g., CKDu, dengue, and air pollution-
related asthma.
21

22. Risk Factors and Disease Trends
Understanding risk factorsand disease trendsis essential for community health nurses to design effective,
preventive, and promotive health interventions.
Category Major Risk Factors Community Health Nursing Focus
Behavioral
•Tobacco use
•Alcohol consumption
•Physical inactivity
•Poor diet
•Health education
•Lifestyle counseling
•Anti-tobacco/alcohol campaigns
Environmental
•Poor sanitation
•Unsafe drinking water
•Vector breeding (e.g., mosquitoes)
•Water purification education
•Waste management
•Vector control awareness
Biological
•Aging population
•Genetic predispositions
•Childhood malnutrition
•Elder care
•Nutritional support
•Early detection/screening
Social/Structural
•Poverty
•Low education
•Gender inequality
•Urban overcrowding
•School health programs
•Women empowerment
•Community outreach
Occupational
•Agrochemical exposure
•Unsafe labor environments
•PPE education
•Occupational health checks in farming zones
Epidemiological Patterns of Disease Cont.
22

23. Disease Epidemiological Trend
Dengue
Seasonal outbreaks (May–July, Oct–
Dec); urban spike
Leptospirosis
Increasing post-floods; linked to
paddy/agriculture
Tuberculosis (TB)
Endemic with hidden burden; post-
conflict clustering
Typhus & Hepatitis A
Linked to poor sanitation, peaks after
monsoon
Epidemiological Patterns of Disease Cont.
Communicable Disease Patterns
23
Vector-borne diseaseslike dengueremain prevalent; dengue cases reached 186,101 in 2017, with recent 2024
counts around 45,610.
Sri Lanka has successfully eradicated diseases such as polio, malaria, neonatal tetanus, and filariasis.

24. Non-Communicable Disease (NCD) Burden
Epidemiological Patterns of Disease Cont.
SriLankanowfacesaNCDepidemic:
Cardiovasculardiseaseaccountsforaboutone-thirdofNCDdeaths.
Diabetesaffects1in5adultsaged35–64years(STEPS2021)
Obesityandhypertensionarerisinginschool-agedchildrenandyouth.
Cancerincidence(especiallybreastandoral)isincreasingduetolatedetection.
Mentalhealthissues(depression,substanceuse)arerisingpost-COVID-19.
EmergingEnvironmental&OccupationalIllnesses
Chronic Kidney Disease of Unknown Etiology(CKDu):
•Linkedtofarmingcommunities(NorthCentralProvince,Uva).
•Associated with dehydration, agrochemicals, and hard water.
•~70,000 affected; over 1,400 annual deaths.
Respiratory conditions are increasing due to:
Urban air pollution, indoor smoke, and occupational exposure.
Vector-borne diseases-ප ෝවනපරෝග(e.g., dengue, chikungunya) are on the rise due to climate change and
poor waste disposal.
24

25. Core Principles for Preventive Program Planning
Needs Assessment: Analyzedemographic & health data at district/Grama Niladharilevel.
Prioritization: Focus on largest burdens or high-risk demographics.
Intersectoral Collaboration: Engage PHMs, PHIs, local government, schools, agriculture departments.
Community Engagement: Use PHM-led mobilization and volunteer networks in estate communities
Monitoring & Evaluation: Use pre-post indicators (e.g., disease reduction, behaviorchange, service uptake).
Evidence-Informed Revisions: Adapt programs based on demographics and outcome data trends.
Preventive Programs
25

26. Data Source Example Nursing Action
Age-specific
morbidity stats
I.High under-5 illness
rates in rural zones
II.Elderly Population
Conduct immunization drives, growth monitoring, and health education.
Provide routine home visits, fall-prevention, mental health support, increase
emphasis on chronic disease monitoring and management, and geriatric care.
NCD prevalence
by region
High diabetes and
hypertension in urban areas
Plan lifestyle clinics and diet counselling programs, implement community-
level screening (BP, glucose), and facilitate chronic care clinics
Maternal
mortality rates
High MMR in estate areas
Early pregnancy registration and ≥4 ANC visits, Enhanced postnatal home
visits by PHMs, especially in vulnerable zones and Nutrition education (Iron,
folate, breastfeeding); protein supplementation for pregnant women
Infectious disease
outbreaks
Rising dengue cases in
Western Province
Tuberculosis &
Leptospirosis
Lead vector-control programs, Community clean-up campaigns before
monsoons, Larval source reduction and fogging coordination, Health
education on symptom recognition and early healthcare seeking, outbreak
response, Use of eDCSsurveillance for hotspot identification and response.
Emphasize environmental hygiene, early diagnosis, DOTS adherence, and
public education
School health
data
High rates of anemia or
scabies in children
Deliver school health programs, deworming, hygiene promotion,Continue
immunizations, and nutrition monitoring
26
Preventive Programs Cont.

27. Summary
Demography is the statistical study of human populations, focusing on size, structure, distribution, and trends.
High population density in Western Province (e.g., Colombo, Gampaha).
Infant Mortality Rate & Under-5 Mortality Rate: Sri Lanka maintains low child mortality rates, signallingstrong
primary care and immunization systems, but continued outreach is vital in underserved/populations with
disparities.
Maternal Mortality Rate: Low but fragile; preventing maternal deaths relies on robust antenatal, delivery, and
postpartum systems, especially in rural and remote settings.
Sri Lanka’s disease burden has shifted heavily toward NCDs, driven by demographic ageing and lifestyle factors.
Communicable diseases, while reduced overall, still pose risks through outbreaks and endemic presence.
Community health nurses must adopt a dual focus: traditional infection control (e.g., vector-borne diseases) and
modern chronic care models (e.g., NCD prevention/management).
Proactive community interventions, surveillance use, health education, and intersectoral collaboration are essential
for addressing Sri Lanka’s evolving public health landscape.
27

28. Stanhope & Lancaster. Public Health Nursing: Population-Centred Health Care in the Community,
10th Ed. (2022)
Park, K. Textbook of Preventive and Social Medicine, 26th Ed. (2021)
Department of Census and Statistics, Sri Lanka –Census 2024 Preliminary Report
Department of Census and Statistics –Population & Health Trends (2024)
Department of Census & Statistics. Vital Statistics 2024
Ministry of Health Sri Lanka –Annual Health Bulletin 2023
WHO Community Health Guidelines
World Health Organization –Sri Lanka NCD Country Profile 2022
References
28

29. Questions?
29